Jeffrey    Hogan    RPT
Contract Details
Ancillary Care Services
Facility name
Provider ID
P000004932
NPI
1609865104
Tax ID
272106883
Effective Date
4/1/2012
Last Updated
10/28/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
88.00
Location Details
Address
16525 Lexington Boulevard Suite 220
Sugar Land, TX 77479
United States
County
Fort Bend
Phone
2812402225 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Physical Therapy
Map
Address